Incident Reporting Guide

Who Must ReportWhat Must Be ReportedWhen and How to ReportWhy It Is Important To Report

Who Must Report

As an employee or agent of a participating entity, you have an individual responsibility to report to your Self-Insurance Program any occurrence that you reasonably believe may have caused or resulted in an injury to a patient.

NOTE: You may also have other additional reporting responsibilities and should be familiar with the policy for reporting events and near misses at the facilities where you practice.

What Must Be Reported

Examples of when to contact your Self-Insurance Program:

In ADDITION to any facility and/or university-related reporting requirements, the following are TYPES OF INCIDENTS THAT YOU SHOULD REPORT TO YOUR SIP.

Total or partial loss of a limb or loss of the use of a limb

Sensory organ or reproductive organ impairment

Any injury to a part of the anatomy not undergoing treatment

Disability or disfigurement

Any assertion by a patient or patient’s family that he/she has been medically injured

Misdiagnosis of a patient’s condition resulting in mortality or increased morbidity

Injury/death to either the child or mother during delivery

Any birth of a term baby that is stillborn or expires shortly after delivery

Any shoulder dystocia resulting in a fracture or other injuries

Any assertion by the patient/family that no consent for treatment (medical/surgical) was given

Any assertion or evidence that the patient was sexually abused, raped, or otherwise sexually assaulted

Medication errors leading to injury, death, or higher level of care

Retained foreign body incidents

Wrong site, wrong patient, wrong procedure

Any incident that results in an unexpected death, brain or spinal damage, or any other injury not referenced above

Any other unexpected adverse condition or outcome that you feel could result in a claim

When you receive licensure investigation letters from the DOH or licensing board

When you receive Notices of Intent to Initiate Litigation for Medical Negligence (NOI)

When you need assistance with deposition/subpoena requests

When you are in need of medical malpractice defense education

When you are in need of continuing education

When you need insurance coverage certifications

Occurrence

An Occurrence is:

any event that has produced an actual, potential, or perceived injury.

a practice, situation, premises, or product defect that may produce an injury if left uncorrected.

any other unexpected or untoward outcome or event where established policy or procedure was not followed.

any other conditions you feel may give rise to a claim.

Allegation

Allegations are written or verbal statements alleging negligence and asserted claims.

These include any assertion by a patient or patient’s family:

that an injury has occurred.

that proper consent was not given for treatment.

that there has been sexual misconduct.

These also include any legal or regulatory agency communications, including:

Notices of Intent to Initiate Litigation for Medical Negligence.

summons and complaints.

letters or phone calls from the Agency for Health Care Administration (AHCA) or the Department of Health (DOH).

letters or phone calls from an attorney.

When and How to Report

Immediately upon the occurrence of a potentially reportable event (as soon as the patient’s needs are addressed), notify your Self-Insurance Program by calling the Gainesville administrative offices:

1-352-273-7006

1-904-244-9070

1-844-MY FL SIP (1-844-693-5747)

PLEASE DO NOT USE E-MAIL TO MAKE REPORTS!!

Information we will need to know:

Name, sex, and age of patient

Medical record number

Date of admission and admission diagnosis

Date, time, and location (e.g., inpatient facility, outpatient clinic) of the occurrence

Brief description of the occurrence with the names of the involved individuals and witnesses

Description of the injury, the treatment provided, and the name(s) of the physician(s) notified

NOTE: Residents must also notify their Attending and department residency program director. Students/Other Staff members must notify their supervisors.

Why It Is Important To Report

Patient Safety and Loss Prevention

Timely reporting allows for the identification of patient safety initiatives and provides insight into opportunities to improve the provision of healthcare.